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Organization

FEDERAL MEDICAL CENTER DEVENS

Active
Other names
Federal Bureau of Prisons
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ALBERTO BETANCES (ASSIST HEALTH SERVICE ADMINISTRATOR)
(978) 796-1400
Entity
Organization

Contact information

Practice address
42 PATTON RD, AYER, MA 01433
(978) 796-1400
Mailing address
35 OAK KNOLL RD, NATICK, MA 01760-1103
(508) 545-0733

Taxonomy

Speciality
Code
Description
License number
State
261QP2400X
Prison Health Clinic/Center
Primary
PA2382
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA2382
STATE PHYSICIAN ASSISTANT LICENSE
MA
Enumeration date
06/30/2010
Last updated
06/30/2010
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